Joe O'Toole (Independent)

The debate concerns an issue I have raised time and again in the past couple of years following the Leas Cross issue. I take on board many of the points made by Senator Fitzgerald in her contribution and I want to hear the Minister of State's response. I have had reservations from the beginning, which I have raised repeatedly, about setting up a new group of inspectors to check nursing homes. My view, which touches on the points raised earlier, is that we should set and organise certain regulations and standards which are required for nursing homes and include them in the wider remit of other specialists.

I do not believe there is any one qualified person who can go into a nursing home and check all the things we would want to check. The report on Leas Cross covered many different areas which are beyond the expertise of any one person, for example, the areas of prescription, running a pharmacy, nursing, attendance and care by doctors, health and safety, diet and other issues. No one person can deal with all these. I would like it to be included in the remit that, for example, local health inspectors would check the issues a health inspector would normally deal with in a restaurant, a pub or a general location; a fire officer would check issues to do with fire safety; a nursing specialist would check specifically the level of nursing standards; and similar would happen with regard to management, cleanliness, housekeeping, diet and so on.

I am not suggesting the Minister would organise and employ a whole raft of people dealing with the areas to which I referred. Instead, I am suggesting that a nursing home in an area would be added to the responsibility of a wider general area. For example, a dietician in the local hospital would have as his or her responsibility to check in a codified manner several times per year and then give an on-line response to a general collecting body which would gather the information as it becomes available.

This is a classic example of the kind of issue the Senators raised yesterday with regard to how we can save money in the public sector. This is to create a whole new body of people to do a job they cannot possibly do. Six months after they are appointed, I will be standing here on behalf of people who have written to tell me a certain nursing home did not have any visits or to ask what the inspectors are doing. They cannot do this job. No one person can check all the areas to which I referred unless he or she spends 25 years qualifying to do so.

This is a management issue. We need to organise the management of nursing home inspection in a way that employs the expertise already available, namely, specialists such as fire officers, health and safety inspectors, pharmacists, nursing inspectors and a variety of other groups. I speak as an Independent who is to an extent disinterested in the issue but I want to know how we can find an effective way of dealing with this question.

The crucial point is that if one was to organise this in the way I suggest, one would not have 25,000 pieces of paper. It would have to be organised as an on-line method so that each of those inspectors would be required to immediately fill in an on-line form which would go straight back into the more general collection. This would save us from much difficulty. We are aware of the issue of publishing reports on nursing homes. This report would grow as each different group or inspector attached to it outlines the situation that was found.

There is no other way this can be done. If I am running a pub or a restaurant, various officials will come in, such as a planning officer, a health and safety inspector or a garda to check the licensing laws. One would not dream of trying to set up a whole new team of people to inspect pubs or restaurants. One would expect those who had responsibility in those areas to do it.

We all reacted to what happened in Leas Cross and other places, which is understandable. However, it is not that simple. We need to consider this in a careful way to ascertain what gives the best value for money, effectiveness and efficiency. It will not be done by a new cadre of inspectors, which should be music to the ears of the Department of Health and Children and the Department of Finance.

Certain issues such as entertainment for and motivation of nursing home residents are important. I have occasion to visit nursing homes on a regular basis and I often see residents sitting around in a circle, as Senator Mary White said. However, at another nursing home I visit I have been impressed that its residents are entertained with singing and can avail of visiting services such as a hairdresser. In my experience most people who have a family member in a nursing home are happy with the level of care and support being given. I accept there were problems at Leas Cross and other homes but what we are doing here is running the rule over them.

Another issue is that many people believe brand new nursing homes have the best standards. In my experience, however, some of the older nursing homes give a far more personal and acceptable service. It all comes down to caring and having caring people working in a nursing home. Those caring people do not have to be Irish either. It all comes down to looking at how best to deal with people.

When people are concerned about the atmosphere in a nursing home, it is usually because of their own experience. People have difficulty in adjusting when they walk into a room with 20 very elderly people, some with Alzheimer's. All we want to do is reassure ourselves that we are approaching this properly and getting the standards right. I accept nursing homes cannot be the Ritz but it is about getting the basics right such as diet, exercise, comfort, cleanliness, nursing and pharmaceutical care.

I want the Minister of State not to take any received wisdom in this area but to make up her own mind on the basis of her own experience. If Ministers' judgment and expedience were not called for, then there would be no need for them. It is Ministers who run the country, not experts.

Mistakes have been made in other areas concerning inspection when cadres of inspectors were promised but not enough were appointed. I do not want nursing homes to be out there as independent satellites, as it were. I want them part and parcel of an operational system which will be dealt with like other aspects of the service industry. While it is an area that touches many of our loved ones, the Minister of State must step back from any sentimentality and decide how to do this best. I wish her well in her portfolio. It is not an easy one but people are supportive of what is required to be done in this area.